The aim: Scientific work aims at determining the frequency and nature of disorders in psycho-emotional and autonomic systems in patients with combined trauma of the middle face. Materials and methods: Examination included 112 patients with combined trauma of the middle face.Their psycho-emotional state was assessed using the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). All patients were tested using questionnaires developed by Wayne A.M.. The Kerdo index was used to assess autonomic tone, while autonomic reactivity was determined using a Czermak-Gering carotid sinus test. Biochemical markers of stress - adrenocorticotropic hormone (ACTH), cortisol and anti-stress system - β-endorphins,and Garkavi L.Kh. adaptation index. Results: Patients with severe traumatic brain injury - 26.78%, and severe fractures of the facial bones - 48.21%. The consequence of traumatic events is the appearance of post-traumatic stress disorders in their mental function. Post-traumatic stress is also manifested at the hematological level in the characteristic stress reactions: the growth in the blood of stress markers - ACTH and cortisol and anti-stress factors, including β-endorphins Conclusions: Middle facial injuries cause disorders of the psycho-emotional sphere, which are manifested in anxiety and depressive disorders. The post-traumatic period is accompanied by stress disorders, which are confirmed by hematological studies with a significant increase in stress markers (ACTH and cortisol) and an insignificant increase in anti-stress factors in the blood. Insufficient stress-limiting function of the hypothalamic-pituitary system slows down the healing process and requires appropriate correction.

A rapidly increasing number of mandibular condylar fractures and some complications related to injuries of temporomandibular elements make this study important. Intra-articular disorders lead to secondary pathological findings such as osteoarthritis, deforming osteoarthrosis, and temporomandibular joint ankylosis that limits mouth opening, mastication, swallowing, breathing, and decreased/lost working capacity or disability. Early diagnosis of intra-articular disorders can prevent from long-lasting functional complications caused by temporomandibular joint injuries. This study was performed for the purpose of early detection and investigation of organic pathological changes in the cartilaginous and osseous tissues of the temporomandibular joint caused by traumatic fractures of the mandibular condyle. Twenty patients underwent a general clinical examination, magnetic resonance imaging (MRI), and immune-enzyme testing for biochemical markers of connective tissue injury (pyridinoline and deoxypyridinoline) in urine. Disk dislocation, deformation, adhesion, perforation or squeeze, tension or disruption of ligaments, and injury of articular surfaces are among complications of mandibular fractures that can be revealed on MRI. As regards biochemical findings, we revealed a sharp rise in the levels of pyridinoline and deoxypyridinoline before treatment and a lack of stabilization within 21 days of treatment.

Objective. To analyze the effectiveness of various methods of laparoscopic antireflux operations in patients with gastroesophageal reflux disease. Materials and methods. The results of treatment of 177 patients with gastroesophageal reflux disease from 2015 to 2021 were analyzed. Patients were divided into three groups: 1st - 62 patients who underwent laparoscopic antireflux surgery of our own modification (Patent of Ukraine No 59772); 2nd - 91 patients who underwent laparoscopic Nissen fundoplication; 3rd - 24 patients who underwent laparoscopic Toupet fundoplication.  Results. 36 months after surgery in the 1st group the recurrence rate of gastroesophageal disease was 1.6%, recurrence of hernia of the esophageal orifice - 1.6%, in the 2nd group - 7.7 and 3.3%, respectively; in the 3rd group - 12.5 and 8.3%, respectively. Conclusions. The application of a new integrated approach to the surgical treatment of gastroesophageal reflux disease reduces the number of postoperative complications (gas -bloat syndrome - 3 times, dysphagia - 5 times), the recurrence rate of gastroesophageal reflux disease - 5 times and recurrence of esophageal hernia - 2 times, improves the quality of life of patients 36 months after surgery in 2.6 times and increases the timeliness of diagnosis and facilitates the choice of differentiated treatment tactics.

Кафедра хірургії та ендоскопії факультету післядипломної освіти (зав.-проф. Б.О. Матвійчук) Львівського національного медичного університету імені Данила Галицького ВІДДАЛЕНІ РЕЗУЛЬТАТИ ХІРУРГІЧНОГО ЛІКУВАННЯ ХВОРИХ НА ГАСТРОЕЗОФАГЕАЛЬНУ РЕФЛЮКСНУ ХВОРОБУ, АСОЦІЙОВАНУ З ГРИЖЕЮ СТРАВОХІДНОГО ОТВОРУ ДІАФРАГМИ Резюме. Вивчено віддалені результати хірургічного лікування хворих на гастроезофагеальну рефлюксну хворобу, асоційовану з грижею стравохідного отвору діафрагми. За стандартною методикою (лапароскопічна фундоплікація за Ніссеном) протягом 2004-2019 років, у клініці прооперовано 188 пацієнтів, що склали 1-у групу досліджень. За власною методикою лапароскопічної операції при ГСОД (патент України № 59772) прооперовано 57 хворих, що склали 2-у групу досліджень. Результати лікування вивчали у кожного пацієнта перед операцією і через 3 та 36 місяців після неї. В першій групі, серед інтраопераційних ускладнень було ушкодження селезінки з кровотечею у 5 (2,7 %) хворих і карбокситоракс у 4 (2,1 %) пацієнтів. У післяопераційному періоді на 2-у добу, в одного хворого, розвинулася ТЕЛА. Летальних випадків не було. Рецидив ГСОД і ГЕРХ діагностовано в 4 обстежених пацієнтів (3,9 %) через 36 місяців після операції. В другій групі, рецидив ГСОД і ГЕРХ-в 1 пацієнта (2,6 %). Не було жодного випадку міграції антирефлюсної манжети, післяопераційних гнійно-септичних чи тромбоемболічних ускладнень. Ключові слова: гастроезофагеальна рефлюксна хвороба, грижа стравохідного отвору діафрагми, лапароскопічні антирефлюксні операції.

Argon coagulation and use of PPIs for 8-12 weeks before surgery led to the regeneration of the mucous membrane in the esophagus. The developed diagnostic and therapeutic algorithm facilitated systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life.